RACE AND ETHNICITY IDENTIFICATION

These questions comply with the U.S. Department of Education's implementation of the Office of Management and Budget's 1997 standards for maintaining, collecting, and presenting federal data on Race and Ethnicity.

Please Check One

EDUCATIONAL INFORMATION

GED (General Education Degree)/ High School Information

*Did you receive a GED?

*Did you receive a high school diploma?

Please give the full name of the High School you attended:

High School Code

GPA (If Known)

List ALL Colleges Previously Enrolled

School Name
City/State
Dates Attended

2nd School Name
2nd City/State
2nd Dates Attended

CITIZENSHIP STATUS (check one)

*U.S. Citizen

If No, What is your Country of Citizenship
Requesting I-20
Visa Number
Visa Expiration Date
Non-Resident/Visa

Religion/Denomination

What is your Native Language

Marital Status

Adults in Household

Children in Household

Are you a Veteran?

If Yes, Military Branch

I am a dependent or spouse of an U.S. active duty service member.

OPTIONAL: Shorter College actively assists persons with disabilities and veterans.